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Discovery of EST73502, a Dual μ-Opioid Receptor Agonist and σ 1 Receptor Antagonist Clinical Candidate for the Treatment of Pain

2020; American Chemical Society; Volume: 63; Issue: 24 Linguagem: Inglês

10.1021/acs.jmedchem.0c01127

1520-4804

Mónica Garcı́a, Marina Virgili, Mónica Alonso, Carles Alegret, Joan Farran, Begoña Fernández, Magda Bordas, Rosalía Pascual, Javier Burgueño, Alba Vidal‐Torres, Antonio R. Fernández de Henestrosa, Eva Ayet, Manuel Merlos, José Miguel Vela, Carlos R. Plata‐Saláman, Carmen Almansa,

Phenothiazines and Benzothiazines Synthesis and Activities

The synthesis and pharmacological activity of a new series of 4-alkyl-1-oxa-4,9-diazaspiro[5.5]undecane derivatives as potent dual ligands for the σ1 receptor (σ1R) and the μ-opioid receptor (MOR) are reported. A lead optimization program over the initial 4-aryl analogues provided 4-alkyl derivatives with the desired functionality and good selectivity and ADME profiles. Compound 14u (EST73502) showed MOR agonism and σ1R antagonism and a potent analgesic activity, comparable to the MOR agonist oxycodone in animal models of acute and chronic pain after single and repeated administration. Contrary to oxycodone, 14u produces analgesic activity with reduced opioid-induced relevant adverse events, like intestinal transit inhibition and naloxone-precipitated behavioral signs of opiate withdrawal. These results provide evidence that dual MOR agonism and σ1R antagonism may be a useful strategy for obtaining potent and safer analgesics and were the basis for the selection of 14u as a clinical candidate for the treatment of pain.